Financial Alignment Initiative
Financial Alignment Initiative for Medicare-Medicaid Enrollees
The Financial Alignment Initiative is designed to provide individuals dually enrolled in Medicare and Medicaid with a better care experience and to better align the financial incentives of both programs. CMS partners with states to test two models: a Capitated Model and a Managed Fee-for-Service Model. These models aim to integrate primary, acute, behavioral health, and long-term services and supports.
Innovation
Testing two new models: a Capitated Model utilizing a three-way contract and prospective blended payments, and a Managed Fee-for-Service Model allowing states to benefit from savings resulting from quality improvement and cost reduction initiatives.
The Problem
There are over 12 million Americans enrolled in both the Medicare and Medicaid programs who need access to high quality, seamless systems of care that better coordinate benefits and services.
The Solution
CMS is working with States to test two models to integrate primary, acute, behavioral health and long-term services and supports for dually eligible individuals and better align the financing of the Medicare and Medicaid programs.
Expected Outcomes
A better care experience for dually enrolled individuals, improved quality of care, reduced costs for both Medicare and Medicaid, and better aligned financial incentives between the two programs.
Strategy
Collaboration between the CMS Innovation Center and the CMS Medicare-Medicaid Coordination Office to partner with states and test new models for their effectiveness in accomplishing care and financial alignment goals.
Model Goals
- Provide individuals dually enrolled for Medicare and Medicaid with a better care experience
- Better align the financial incentives of the Medicare and Medicaid programs
- Increase access to high quality, seamless systems of care that better coordinate benefits and services
Patient Eligibility
Individuals must be dually enrolled in both the Medicare and Medicaid programs.
- Dually enrolled for Medicare and Medicaid
Provider Eligibility
States must submit a proposal and develop a Memorandum of Understanding (MOU) with CMS. For the Capitated Model, health plans must enter into a three-way contract with the State and CMS.
- State must develop a Memorandum of Understanding (MOU) with CMS
- Health plans must enter into a three-way contract with the State and CMS (Capitated Model)
Care Categories
Comprehensive Care
CMS Benchmarks & Thresholds
operational
population
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